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09060122UP .Z n�N s� m� W F X03y Zinc ng +u—rn 'EFC �Z C Z� .� W? �DZ UC V4 F OV E.t a ►-t tf. U t— CITY OF CUPERTINO BUILDING DIVISION PERMIT ('� �'Fi `�ti.�. �}I� t��?:�NF'���* BUILDING ADDRESS: PERMIT NO. 21949 FT -)WART) WAY ED SEEVICE INC 09060122 OWNER'S NAME: _ATRE PERMIT ISSUE DATE "O A CONTROL NO. (408)934-8844 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 o a 0 LICENSED CONTRACTOR'S DECLARATION 9 .lob Description I hereby affirm that I am licensed under provisions of Chapter (commencing with Section 70(X0) of Division 3 of the B and Professions Code, and m license is in full force and �_3 �jrj RMV&RPLC A/C License C asa Lic. at Date G Contractor rs ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $5800 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (Ss00) 35619003 0 0 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, . Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec. B & P C for this mason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self -insure for Workers Compen- ...tion, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Co �yt�ion I ranee carrier and Policy number am - �n Cartier. '57� ao•eJ•0 Policy No.: Carrier. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I cenifv that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date _ Applicant - - NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Wooer's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.) Lenders Name Lenders Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTAN D WILL MPLY WITH ALL NON -POINT z uATT -L,/ Issued by: Date _ 1 1 -F ��� Z,�G,cz Re -roofs Type of Roof Sign re of Applicant/Contractor —62te— HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ,,� ❑Yes "O All roofs shall be inspected prior to any roofing material being installed. /"-' If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new IT aterials for inspection. strict? ❑ Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to notify the occupant of the requircmc whichmust Pc met issu oCaCcrtiftcatcof pancy Signature of Applicant Date All roof coverings to be Class 'J#.`' or better Date Owne or authorized agent Z CITY Of CUPEkTINO CITY OF CUPERTINO FURVACE/AC PERMIT APPLICATION FORM Ogoy�i [�� APN # 1 Cl/ / � (�� � � v Date: (v Building Ad ress: 1-94A .4 Owner's Name: _ / Awwe /0 •A/ Phre #: --1166 -/13!5- Contradior: ` Phone #: Fax #: 10(e Contractor License #: Cupertino Business License #: Contact: . / Phone #: C Fax #: Building Permit Info: Elect Plumb Mech 19 Residential Commercial ❑ Job Description: ,1 For Residential Installations: Attic ❑ 1St floor [3' 2nd floor ❑ Adhere to minimum setback requirement [� For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): -- StrappedEl On Platform Bonded New Location Replacement Project Size: Express ❑ Standard g Large ❑ Major ❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Kevised 0 1iu iiuy -1 aV111-1 CITY Of CUPEkTINO CITY OF C UPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Rep�Lir/Alteration/Add to M ea heating appliar.ce,refrigeration unit, cooling unit,absoiption unit,or ea heating, cooling, absorption or evaporative cooling system,incl installation of cor. trols regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,'IAV boxes, absorption unit or ea heathing, cooling absorption,or eva)orative cooling sys, incl install of controls regulated by this code. 1 MCSUSHTR Commercial Inste ll/Relocate ea M suspended heater,recessed wall htr, or floor mounted un.t heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1 MCAPPVNT Commercial for t -le install/relocate/ or M replacement of ezappliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standar is Commission Fee B ALL PERMIT TYPES IBSEISMICO Commercial Seismic B 1 MRRAA Residential Repa: r/Alteration/Add to M ea heating appliaiice,refrigeration unit, r cooling unit,absorption unit,or ea I heating,cooling, a b sorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Instal I/Relocate ea M suspended heater,recessed wall htr, or floor mounted un it heater. CITY OF C'UPERTINO FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B FURN/AC 1 MCRAA Commercial Meeh Repair/alt/add M IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICO Seismic Commercial B 1 PGASCOM Commerical for ca gas piping System 1-4 outlets P 1PGASRES Residential for e�L gas piping system of 1-4 Outlets P 1 BPGAS For each gas piping system of 5 or more per outlet. Comm/Resid P 1BREMAIRHAN Residential A/C units <= l0k CFM B 1 MRRAA Residential Mecr. Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1BSEISMICR Seismic Residential B J I EPERMITFEE Electric Permit E 1 MPERMITFEE Mechanical Perry.. it M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B 1. Use lowlNo-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Seal a1l E)Wsed.Particleboard or MDF 4 IAQ/Health, pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: Total Points Project Received: 1401 1301 57 01 0 0 G:dat ogs/grf enbuildingguidelin remodelers/greenpointsfinal2.12.04protected.As Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: A PERMIT # OWNER'S NAME: x'/, e�` i e PHONE # GENERAL CONTRACTOR FAX # p I am not using any subcontractors: Signature Date PlPaae rbeck applicable subcontractors and complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date